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O’Grady JR, Ferdus J, Leylachian S, Bolarinwa Y, Wagamese J, Ellison LK, Siedule C, Batista R, Sheppard AJ. Lung cancer in First Nations, Inuit, and Métis peoples in Canada - a scoping review. Int J Circumpolar Health 2024; 83:2381879. [PMID: 39074244 PMCID: PMC11288199 DOI: 10.1080/22423982.2024.2381879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Lung cancer is one of the most commonly diagnosed cancers in Canada and a leading cause of cancer mortality. Lung cancer also affects First Nations, Inuit and Métis peoples significantly in Canada, which deserves further investigation as there is a literature gap on this topic. We sought to develop a deeper understanding of lung cancer diagnosis, incidence, mortality, and survival in First Nations, Inuit, and Métis peoples in Canada. A systematic search was conducted in bibliographic databases to identify relevant studies published between January 2000 and March 2023. Articles were screened and assessed for relevance using the Population/ Concept/ Context (PCC) framework. A total of 22 articles were included in the final analysis, of which 13 were Inuit-specific, 7 were First Nations-specific, and 2 were Métis-specific. The literature suggests that comparative incidence, mortality, and relative risk of lung cancer is higher and survival is poorer in First Nations, Inuit and Métis peoples. Lung cancer also has varying impact on these population depending on sex, age, location and other factors. This review illustrates that more comprehensive quantitative and qualitative lung cancer research is essential to further identify the structural causes for the high incidence of the disease.
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Affiliation(s)
| | - Jannatul Ferdus
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Sayna Leylachian
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
| | - Yinka Bolarinwa
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Joshua Wagamese
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Lisa K Ellison
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
| | - Connie Siedule
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Ricardo Batista
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Amanda J Sheppard
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Sethi S, Ju X, Logan R, Hedges J, Garvey G, Jamieson L. Lip, oral and oropharyngeal cancer incidence among Aboriginal and Torres Strait Islander Peoples: First report from Australian population-based cancer registry, 1999-2018. Aust Dent J 2024; 69:182-188. [PMID: 38469883 DOI: 10.1111/adj.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The Australian Burden of Disease Study has shown that cancer is the single most important entity responsible for the greatest cause of health burden in Australia. Unfortunately, Aboriginal and Torres Strait Islander peoples experience a greater burden of this disease, with cancer of the lung, breast, bowel and prostrate being the most common. Lip, oral cavity and pharyngeal cancer incidence is rapidly rising globally and is now the sixth most common cancer in Australia. This paper aims to summarize, for the first time, the incidence and prevalence trends of lip, oral cavity and pharyngeal cancers in Aboriginal and Torres Strait Islander Australians. METHODS Data were obtained from the Australian Cancer Database (ACD), which is compiled at the Australian Institute of Health and Welfare (AIHW) from 1999 to 2018 to estimate the incidence and prevalence of certain head and neck cancers (ICD-10 codes C00-C10, C14). The other variables requested were age groups and sex. RESULTS Results were stratified by ICD-10 code, sex and age group at diagnosis and time period (i.e. grouped years of diagnosis). The total incidence of lip, oral cavity and pharyngeal cancers increased by 1.3 times from 1999 to 2008 (107/100 000) to 2009-2018 (135/100 000). The overall 5-year prevalence of lip, oral cavity and pharyngeal cancers was 0.17% (0.24% for men and 0.09% for women). CONCLUSIONS The significantly increased incidence of lip, oral cavity and pharyngeal cancers in Aboriginal and Torres Strait Islander peoples in Australia is concerning and should be explored. A targeted, comprehensive and culturally safe model of care for Aboriginal and Torres Strait Islander peoples with lip, oral cavity and pharyngeal cancers is imperative.
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Affiliation(s)
- S Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - X Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - R Logan
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - G Garvey
- Faculty of Medicine, School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - L Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Signal V, Smith M, Costello S, Davies A, Dawkins P, Jackson CGCA, Koea J, Whitehead J, Gurney J. Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence. Cancer Causes Control 2024:10.1007/s10552-024-01904-1. [PMID: 39150625 DOI: 10.1007/s10552-024-01904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/06/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Lung cancer is a deadly cancer. Early diagnosis and access to timely treatment are essential to maximizing the likelihood of survival. Indigenous peoples experience enduring disparities in lung cancer survival, and disparities in access to and through lung cancer services is one of the important drivers of these disparities. In this manuscript, we aimed to examine the current evidence on disparities in Indigenous access to services along the lung cancer treatment pathway. METHODS A narrative literature review was conducted for all manuscripts and reports published up until July 20, 2022, using Medline, Scopus, Embase, and Web of Science. Following the identification of eligible literature, full-text versions were scanned for relevance for inclusion in this review, and relevant information was extracted. After scanning 1,459 documents for inclusion, our final review included 36 manuscripts and reports that included information on lung cancer service access for Indigenous peoples relative to non-Indigenous peoples. These documents included data from Aotearoa New Zealand, Australia, Canada, and the USA (including Hawai'i). RESULTS Our review found evidence of disparities in access to, and the journey through, lung cancer care for Indigenous peoples. Disparities were most obvious in access to early detection and surgery, with inconsistent evidence regarding other components of the pathway. CONCLUSION These observations are made amid relatively scant data in a global sense, highlighting the need for improved data collection and monitoring of cancer care and outcomes for Indigenous peoples worldwide. Access to early detection and guideline-concordant treatment are essential to addressing enduring disparities in cancer survival experienced by Indigenous peoples globally.
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Affiliation(s)
- Virginia Signal
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - Moira Smith
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | | | - Anna Davies
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - Paul Dawkins
- Te Whatu Ora - Counties Manukau, Auckland, New Zealand
| | | | | | | | - Jason Gurney
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand.
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Rouhafzay A, Yousefi J. Geographical Disparities in Colorectal Cancer in Canada: A Review. Curr Oncol Rep 2024:10.1007/s11912-024-01574-x. [PMID: 39073526 DOI: 10.1007/s11912-024-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE OF REVIEW Colorectal cancer (CRC) is a prominent contributor to cancer-related mortality in Canada. This review paper sheds light on the research conducted in Canada to scrutinize the influence of economicfactors. The review seeks to uncover notable disparities in Colorectal cancer incidence and mortality rate across diverse Canadian populations, including Indigenous communities, rural dwellers, and individuals with lower socioeconomic status (SES). RECENT FINDINGS Recent investigations reveal significant disparities in CRC incidence, mortality, and treatment outcomes among various demographic groups in Canada. Indigenous peoples, rural populations, and those with lower SES are particularly vulnerable to these disparities. Access to screening and specialized cancer care is notably limited for these marginalized populations, exacerbating existing health inequities. Furthermore, emerging evidence underscores the potential influence of dietary factors on CRC risk, highlighting the importance of tailored prevention and treatment strategies. The findings underscore the urgent need for targeted interventions aimed at enhancing access to CRC screening and specialized cancer care for disadvantaged populations in Canada. By addressing these disparities, more individuals can undergo timely screening and receive early-stage diagnoses, thereby improving prognosis and ultimately saving lives. However, to effectively bridge these gaps, further research is imperative to elucidate the underlying mechanisms driving these disparities and to identify and implement effective interventions.
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Affiliation(s)
- Asal Rouhafzay
- Shannon School of Business, Cape Breton University, Sydney, NS, Canada
| | - Jamileh Yousefi
- Shannon School of Business, Cape Breton University, Sydney, NS, Canada.
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.
- Nova Scotia Health Authority, Halifax, NS, Canada.
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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024; 12:556-574. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Dordunoo D, Limoges J, Chiu P, Puddester R, Carlsson L, Pike A. Genomics-informed nursing strategies and health equity: A scoping review protocol. PLoS One 2023; 18:e0295914. [PMID: 38100433 PMCID: PMC10723661 DOI: 10.1371/journal.pone.0295914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE The objective of this scoping review is to map the available evidence on strategies that nurses can use to facilitate genomics-informed healthcare to address health disparities. INTRODUCTION Advancements in genomics over the last two decades have led to an increase in the delivery of genomics-informed health care. Although the integration of genomics into health care services continues to enhance patient outcomes, access to genomic technologies is not equitable, exacerbating existing health disparities amongst certain populations. As the largest portion of the health workforce, nurses play a critical role in the delivery of equitable genomics-informed care. However, little is known about how nurses can help address health disparities within the context of genomics-informed health care. A review of the literature will provide the necessary foundation to identify promising practices, policy, and knowledge gaps for further areas of inquiry. INCLUSION CRITERIA We will include papers that explore strategies that nurses can undertake to facilitate genomics-informed care to address health disparities. METHODS This review will be conducted using JBI methodology for scoping reviews. We will search electronic databases including MEDLINE (OVID), EMBASE, Cochrane Library, PsychInfo, and CINAHL for quantitative and qualitative studies, systematic reviews and grey literature. Theses, books, and unavailable full-text papers will be excluded. The search will be limited to papers from 2013 and beyond. Two reviewers will screen titles and abstracts followed by full-text and disagreements will be resolved by a third reviewer. We will use a data extraction tool using Microsoft Excel and analyse data using descriptive statistics and conventional content analysis. Findings will be presented in the form of evidence tables and a narrative summary. We will report findings using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). DISCUSSION Genomics will continue to transform all aspects of health care across the wellness continuum from prevention, assessment, diagnosis, management, treatment, and palliative care. The identification of nursing strategies to address health disparities will build the foundation for policy and practice to ensure that the integration of genomic technologies benefits everyone.
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Affiliation(s)
- Dzifa Dordunoo
- University of Victoria, School of Nursing, Director, Centre for Evidence informed Nursing and Health Care: JBI Centre of Excellence, Victoria, Canada
| | - Jacqueline Limoges
- Athabasca University, Chair, Ontario Cancer Research Ethics Board, Toronto, Canada
| | | | - Rebecca Puddester
- Memorial University of Newfoundland, Faculty of Nursing, St. John’s, Canada
| | | | - April Pike
- Memorial University of Newfoundland, Faculty of Nursing, St. John’s, Canada
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Simkin J, Khoo E, Darvishian M, Sam J, Bhatti P, Lam S, Woods RR. Addressing Inequity in Spatial Access to Lung Cancer Screening. Curr Oncol 2023; 30:8078-8091. [PMID: 37754501 PMCID: PMC10529474 DOI: 10.3390/curroncol30090586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The successful implementation of an equitable lung cancer screening program requires consideration of factors that influence accessibility to screening services. METHODS Using lung cancer cases in British Columbia (BC), Canada, as a proxy for a screen-eligible population, spatial access to 36 screening sites was examined using geospatial mapping and vehicle travel time from residential postal code at diagnosis to the nearest site. The impact of urbanization and Statistics Canada's Canadian Index of Multiple Deprivation were examined. RESULTS Median travel time to the nearest screening site was 11.7 min (interquartile range 6.2-23.2 min). Urbanization was significantly associated with shorter drive time (p < 0.001). Ninety-nine percent of patients with ≥60 min drive times lived in rural areas. Drive times were associated with sex, ethnocultural composition, situational vulnerability, economic dependency, and residential instability. For example, the percentage of cases with drive times ≥60 min among the least deprived situational vulnerability group was 4.7% versus 44.4% in the most deprived group. CONCLUSIONS Populations at risk in rural and remote regions may face more challenges accessing screening services due to increased travel times. Drive times increased with increasing sociodemographic and economic deprivations highlighting groups that may require support to ensure equitable access to lung cancer screening.
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Affiliation(s)
- Jonathan Simkin
- BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 4C2, Canada
| | - Edwin Khoo
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Maryam Darvishian
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Janette Sam
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1G1, Canada; (P.B.); (R.R.W.)
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen Lam
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Ryan R. Woods
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1G1, Canada; (P.B.); (R.R.W.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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Jackson EB, Simmons CE, Chia SK. Current Challenges and Disparities in the Delivery of Equitable Breast Cancer Care in Canada. Curr Oncol 2023; 30:7263-7274. [PMID: 37623008 PMCID: PMC10453522 DOI: 10.3390/curroncol30080527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Recent exciting advances in the diagnosis and management of breast cancer have improved outcomes for Canadians diagnosed and living with breast cancer. However, the reach of this progress has been uneven; disparities in accessing care across Canada are increasingly being recognized and are at risk of broadening. Members of racial minority groups, economically disadvantaged individuals, or those who live in rural or remote communities have consistently been shown to experience greater challenges in accessing 'state of the art' cancer care. The Canadian context also presents unique challenges-vast geography and provincial jurisdiction of the delivery of cancer care and drug funding create significant interprovincial differences in the patient experience. In this commentary, we review the core concepts of health equity, barriers to equitable delivery of breast cancer care, populations at risk, and recommendations for the advancement of health equity in the Canadian cancer system.
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Affiliation(s)
- Emily B. Jackson
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Christine E. Simmons
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen K. Chia
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Chan J, Griffiths K, Turner A, Tobias J, Clarmont W, Delaney G, Hutton J, Olson R, Penniment M, Bourque JM, Brundage M, Rodin D, Slotman B, Yap ML. Radiation Therapy and Indigenous Peoples in Canada and Australia: Building Paths Toward Reconciliation in Cancer Care Delivery. Int J Radiat Oncol Biol Phys 2023; 116:421-429. [PMID: 36990919 DOI: 10.1016/j.ijrobp.2022.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/17/2022] [Accepted: 09/28/2022] [Indexed: 03/29/2023]
Abstract
Indigenous peoples represent approximately 5% of the world's population and reside in over 90 countries worldwide. They embody a rich diversity of cultures, traditions, languages and relationships with the land that are shared through many generations and that are distinct from those of the settler societies within which they now live. Many Indigenous peoples have a shared experience of discrimination, trauma, and violation of rights, rooted in complex sociopolitical relationships with settler societies that are still ongoing. This results in continuing social injustices and pronounced disparities in health for many Indigenous peoples around the globe. Indigenous peoples exhibit a significantly higher cancer incidence, mortality, and poorer survival compared to non-Indigenous peoples. Cancer services, including radiotherapy, have not been designed to support the specific values and needs of Indigenous populations, resulting in poorer access to cancer services for Indigenous peoples globally across the entire cancer care spectrum. Specific to radiotherapy, available evidence demonstrates disparities in radiotherapy uptake between Indigenous and non-Indigenous patients. Radiotherapy centres are also located disparately further away from Indigenous communities. Studies are limited by a lack of Indigenous-specific data to help inform effective radiotherapy delivery. Recent Indigenous-led partnerships and initiatives have helped to address existing gaps in cancer care, and radiation oncologists play an important role in supporting such efforts. In this article, we present an overview of access to radiotherapy for Indigenous peoples in Canada and Australia, with a focus on strengthening cancer care delivery through education, partnerships, and research.
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Lightfoot N, Manitowabi D, Arrandale V, Barnett N, Wabegijig-Nootchtai C, Odjig ML, Moulton J, Fongemy J, Larivière M, Kerekes Z, Holness L, MacEwan L, Eger T, Warry W. Workers’ compensation experience in some Indigenous Northern Ontario communities. Work 2022; 73:707-717. [DOI: 10.3233/wor-210895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: There is a dearth of research about occupational health and safety experience in Indigenous communities and compensation applications from Indigenous workers appear limited. OBJECTIVE: This qualitative descriptive study was designed to explore workers’ compensation experiences in some Canadian Indigenous communities. METHODS: A community-based participatory research approach was used to conduct focus groups (n = 25 participants) in three Northeastern Ontario (NEO) Indigenous communities and at one NEO Indigenous employment centre. Semi-structured focus group questions addressed community experience with workers’ compensation, the compensation process, and discussion of a training session about the process. Reflexive thematic analysis followed Braun and Clarke procedures. RESULTS: Discussion with study participants resulted in these themes: 1) both lack of knowledge, and knowledge, about compensation demonstrated, 2) impact of lack of compensation coverage and need for universal coverage on reserve, 3) need for community training sessions about workers’ compensation, 4) workload and financial impact of workers’ compensation on reserve, and 5) requirement for cultural competence training in the compensation board. CONCLUSIONS: This qualitative descriptive study revealed the: need for more information about applying for workers’ compensation and navigating the process, need for universal workplace insurance coverage in Indigenous communities, demand for community-based compensation process training, community costs of compensation, and the requirement for cultural safety and competence training for compensation organization employees. More education about the workers’ compensation process would be of benefit to leadership, health care providers, administrative personnel, employers, and employees on reserves. Nurses in community health centres are well situated to provide further guidance.
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Affiliation(s)
- Nancy Lightfoot
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada
| | - Darrel Manitowabi
- Human Sciences Division, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Victoria Arrandale
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nathaniel Barnett
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada
| | | | - Mary Lynn Odjig
- Economic Development, Wiikwemkoong Development Commission, Wiikwemkoong, ON, Canada
| | - Jeff Moulton
- Human Resources and Shared Services, Sagamok Anishnawbek, Massey, ON, Canada
| | - Julie Fongemy
- Office of the Worker Adviser, Ontario Ministry of Labour, Sault Ste. Marie, ON, Canada
| | - Michel Larivière
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada
| | - Zsuzsanna Kerekes
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada
| | - Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Leigh MacEwan
- School of Social Work, Laurentian University, Sudbury, ON, Canada
| | - Tammy Eger
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada
| | - Wayne Warry
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
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Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137705. [PMID: 35805361 PMCID: PMC9265828 DOI: 10.3390/ijerph19137705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/28/2022]
Abstract
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.
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Bryan JM, Alavian S, Giffin D, LeBlanc C, Liu J, Phalpher P, Shelton D, Morris J, Lim R. CAEP 2021 Academic Symposium: recommendations for addressing racism and colonialism in emergency medicine. CAN J EMERG MED 2022; 24:144-150. [PMID: 35020176 PMCID: PMC8752581 DOI: 10.1007/s43678-021-00244-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
Purpose Racism and colonialism impact health, physician advancement, professional development and medical education in Canada. The Canadian Association of Emergency Physicians (CAEP) has committed to addressing inequities in health in their recent statement on racism. The objective of this project was to develop recommendations for addressing racism and colonialism in emergency medicine. Methods The authors, in collaboration with a 40 member working group, conducted a literature search, held a community consultation, solicited input from expert medical, academic and community advisors, conducted a national survey of emergency physicians, and presented draft recommendations at the 2021 CAEP Academic Symposium on Equity, Diversity and Inclusion for a live facilitated discussion with a post-session survey. Results Sixteen recommendations were generated in the areas of patient care, hospital and departmental commitment to Equity, Diversity, and Inclusion, physician advancement, and professional development and medical education. Conclusion Emergency physicians are uniquely positioned to promote equity at each encounter with patients, peers and learners. The 16 recommendations presented here are practical steps to countering racism and colonialism everyday in emergency medicine. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-021-00244-2.
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Affiliation(s)
- Jennifer M Bryan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sara Alavian
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dawn Giffin
- Department of Emergency Medicine, London Health Sciences Centre, London, ON, Canada
| | - Constance LeBlanc
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - James Liu
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Prashant Phalpher
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- William Osler Health System, Brampton, ON, Canada
| | - Dominick Shelton
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Judy Morris
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
| | - Rodrick Lim
- Department of Paediatrics and Medicine, Western University, London, ON, Canada
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13
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Sâkipakâwin: Assessing Indigenous Cancer Supports in Saskatchewan Using a Strength-Based Approach. Curr Oncol 2021; 29:132-143. [PMID: 35049686 PMCID: PMC8775083 DOI: 10.3390/curroncol29010012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Given that the health care system for Indigenous people tends to be complex, fragmented, and multi-jurisdictional, their cancer experiences may be especially difficult. This needs assessment study examined system-level barriers and community strengths regarding cancer care experiences of Indigenous people in Saskatchewan. Guided by an advisory committee including Indigenous patient and family partners, we conducted key informant interviews with senior Saskatchewan health care administrators and Indigenous leaders to identify supports and barriers. A sharing circle with patients, survivors, and family members was used to gather cancer journey experiences from Indigenous communities from northern Saskatchewan. Analyses were presented to the committee for recommendations. Key informants identified cancer support barriers including access to care, coordination of care, a lack of culturally relevant health care provision, and education. Sharing circle participants discussed strengths and protective factors such as kinship, connection to culture, and spirituality. Indigenous patient navigation, inter-organization collaboration, and community relationship building were recommended to ameliorate barriers and bolster strengths. Recognizing barriers to access, coordination, culturally relevant health care provision, and education can further champion community strengths and protective factors and frame effective cancer care strategies and equitable cancer care for Indigenous people in Saskatchewan.
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14
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DECOLONIZING CANCER CARE IN CANADA. J Cancer Policy 2021; 30:100309. [DOI: 10.1016/j.jcpo.2021.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
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15
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Yu J, Dwyer-Lindgren L, Bennett J, Ezzati M, Gustafson P, Tran M, Brauer M. A spatiotemporal analysis of inequalities in life expectancy and 20 causes of mortality in sub-neighbourhoods of Metro Vancouver, British Columbia, Canada, 1990-2016. Health Place 2021; 72:102692. [PMID: 34736154 PMCID: PMC7615115 DOI: 10.1016/j.healthplace.2021.102692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
Spatially varying baseline data can help identify and prioritise actions directed to determinants of intra-urban health inequalities. Twenty-seven years (1990-2016) of cause-specific mortality data in British Columbia, Canada were linked to three demographic data sources. Bayesian small area estimation models were used to estimate life expectancy (LE) at birth and 20 cause-specific mortality rates by sex and year. The gaps in LE for males and females ranged from 6.9 years to 9.5 years with widening inequality in more recent years. Inequality ratios increased for almost all causes, especially for HIV/AIDS and sexually transmitted infections, maternal and neonatal disorders, and neoplasms.
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Affiliation(s)
- Jessica Yu
- School of Population of Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, United States.
| | - James Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom.
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom; MRC Centre for Environment and Health, Imperial College London, London, United Kingdom; Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, United Kingdom.
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Martino Tran
- School of Community and Regional Planning, University of British Columbia, 433 - 6333 Memorial Road, Vancouver, BC, V6T 1Z2, Canada.
| | - Michael Brauer
- School of Population of Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, United States.
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16
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Implementing and Sustaining Early Cancer Diagnosis Initiatives in Canada: An Exploratory Qualitative Study. Curr Oncol 2021; 28:4341-4356. [PMID: 34898549 PMCID: PMC8628805 DOI: 10.3390/curroncol28060369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The interval between suspected cancer and diagnosis for symptomatic patients is often fragmented, leading to diagnosis delays and increased patient stress. We conducted an exploratory qualitative study to explore barriers and facilitators to implementing and sustaining current initiatives across Canada that optimize early cancer diagnosis, with particular relevance for symptomatic patients. Methods: The national study included a document review and key informant interviews with purposefully recruited participants. Data were analyzed by two researchers using descriptive statistics and thematic analysis. Results: Twenty-two participants from eight provinces participated in key informant interviews and reported on 17 early cancer diagnosis initiatives. Most initiatives (88%) were in early phases of implementation. Two patient-facing and eight provider/organization barriers to implementation (e.g., lack of stakeholder buy-in and limited resources) and five facilitators for implementation and sustainability were identified. Opportunities to improve early cancer diagnosis initiatives included building relationships with stakeholders, co-creating initiatives, developing initiatives for Indigenous and underserved populations, optimizing efficiency and sustainability, and standardizing metrics to evaluate impact. Conclusion: Early cancer diagnosis initiatives in Canada are in early implementation phases. Lack of stakeholder buy-in and limited resources pose a challenge to sustainability. We present opportunities for funders and policymakers to optimize the use and potential impact of early cancer diagnosis initiatives.
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17
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Chahal D, Marquez V, Hussaini T, Kim P, Chung SW, Segedi M, Chartier-Plante S, Scudamore CH, Erb SR, Salh B, Yoshida EM. End stage liver disease etiology & transplantation referral outcomes of major ethnic groups in British Columbia, Canada: A cohort study. Medicine (Baltimore) 2021; 100:e27436. [PMID: 34678872 PMCID: PMC8542110 DOI: 10.1097/md.0000000000027436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/17/2021] [Indexed: 01/15/2023] Open
Abstract
Liver disease etiology and transplantation outcomes may vary by ethnicity. We aimed to determine if disparities exist in our province.We reviewed the provincial database for liver transplant referrals. We stratified cohorts by ethnicity and analyzed disease etiology and outcomes.Four thousand nine hundred sixteen referrals included 220 South Asians, 413 Asians, 235 First Nations (Indigenous), and 2725 Caucasians. Predominant etiologies by ethnicity included alcohol (27.4%) and primary sclerosing cholangitis (PSC) (8.8%) in South Asians, hepatitis B (45.5%) and malignancy (13.9%) in Asians, primary biliary cholangitis (PBC) (33.2%) and autoimmune hepatitis (AIH) (10.8%) in First Nations, and hepatitis C (35.9%) in Caucasians. First Nations had lowest rate of transplantation (30.6%, P = .01) and highest rate of waitlist death (10.6%, P = .03). Median time from referral to transplantation (268 days) did not differ between ethnicities (P = .47). Likelihood of transplantation increased with lower body mass index (BMI) (hazard ratio [HR] 0.99, P = .03), higher model for end stage liver disease (MELD) (HR 1.02, P < .01), or fulminant liver failure (HR 9.47, P < .01). Median time from referral to ineligibility status was 170 days, and shorter time was associated with increased MELD (HR 1.01, P < .01), increased age (HR 1.01, P < .01), fulminant liver failure (HR 2.56, P < .01) or South Asian ethnicity (HR 2.54, P < .01). Competing risks analysis revealed no differences in time to transplant (P = .66) or time to ineligibility (P = .91) but confirmed increased waitlist death for First Nations (P = .04).We have noted emerging trends such as alcohol related liver disease and PSC in South Asians. First Nations have increased autoimmune liver disease, lower transplantation rates and higher waitlist deaths. These data have significance for designing ethnicity specific interventions.
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Affiliation(s)
- Daljeet Chahal
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vladimir Marquez
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trana Hussaini
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - Peter Kim
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Stephen W. Chung
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Maja Segedi
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Stephanie Chartier-Plante
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Charles H. Scudamore
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Siegfried R. Erb
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baljinder Salh
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric M. Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
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Palmer AL, Wong-Francq K, Setton E. Cancer and the Environment projects with four First Nations organizations: working together to address concerns about carcinogens in the environment. Canadian Journal of Public Health 2021; 113:227-238. [PMID: 34669182 PMCID: PMC8975920 DOI: 10.17269/s41997-021-00571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022]
Abstract
Setting For First Nations people, human health and well-being are interconnected with a healthy environment. First Nations organizations commonly raise concerns regarding carcinogens in the environment; however, few case studies are available as guidance for working in a participatory and respectful way to help assess and address these concerns. Intervention Through four community-led pilot projects executed over two years, we collaborated with 15 participants from four First Nations organizations across four provinces to identify concerns related to environmental carcinogens and to address those concerns through an integrated knowledge translation (KT) approach. We co-developed and implemented strategic KT plans for each pilot project, and conducted evaluation surveys and interviews with participants at multiple time points to assess process, progress, barriers and facilitators, and impact. Outcomes The activities and outputs of the pilot projects are available at www.carexcanada.ca. Participants identified 18 concerns, and we co-developed 24 knowledge products. Tailored fact sheets for communities and briefing notes for leadership were deemed most useful; interactive maps were deemed less useful. Evaluation indicated that the collaborative projects were effective in addressing the concerns raised regarding exposures to carcinogens. Implications The participant-led approach and multi-year funding to support capacity enhancement and face-to-face engagement were facilitators to project success. However, participants did face important barriers to collaborate which should be considered in future projects of this kind: the most important being a lack of resources (people and time), given competing and often more urgent priorities.
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Affiliation(s)
- Alison L Palmer
- CAREX Canada, Faculty of Health Sciences, Simon Fraser University, Harbour Centre Campus, Suite 2602, 515 West Hastings St, Vancouver, BC, V6B 5K3, Canada.
| | - Katy Wong-Francq
- Office of the Vice President, Research and International, University of Waterloo, Waterloo, ON, Canada
| | - Eleanor Setton
- Department of Geography, University of Victoria, Victoria, BC, Canada
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19
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Rieger KL, Bennett M, Martin D, Hack TF, Cook L, Hornan B. Digital Storytelling as a Patient Engagement and Research Approach With First Nations Women: How the Medicine Wheel Guided Our Debwewin Journey. QUALITATIVE HEALTH RESEARCH 2021; 31:2163-2175. [PMID: 34238067 PMCID: PMC8564217 DOI: 10.1177/10497323211027529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
When research is conducted from a Western paradigm alone, the findings and resultant policies often ignore Indigenous peoples' health practices and fail to align with their health care priorities. There is a need for decolonized approaches within qualitative health research to collaboratively identify intersecting reasons behind troubling health inequities and to integrate Indigenous knowledge into current health care services. We engaged with First Nations women to explore to what extent digital storytelling could be a feasible, acceptable, and meaningful research method to inform culturally safe health care services. This novel approach created a culturally safe and ethical space for authentic patient engagement. Our conversations were profound and provided deep insights into First Nations women's experiences with breast cancer and guidance for our future qualitative study. We found that the digital storytelling workshop facilitated a Debwewin journey, which is an ancient Anishinabe way of knowing that connects one's heart knowledge and mind knowledge.
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Affiliation(s)
- Kendra L. Rieger
- Trinity Western University, Langley, British
Columbia, Canada
- University of Manitoba, Winnipeg, Manitoba,
Canada
| | | | - Donna Martin
- University of Manitoba, Winnipeg, Manitoba,
Canada
| | | | | | - Bobbie Hornan
- Pimicikamāk Nīhithawī First Nation, Manitoba,
Canada
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20
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Rodin D, Dare AJ, Booker R, Booth C, Bryant H, Ginsburg O, Giuliani M, Gospodarowicz M, Gupta S, Hammad N, Rosberger Z, Sutcliffe S, Earle CC. Transforming Canada's role in global cancer control. Lancet Oncol 2021; 22:e400-e409. [PMID: 34478676 DOI: 10.1016/s1470-2045(21)00374-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
Cancer has not been an explicit priority of Canada's international health and development agenda, but it is key to realising the country's Sustainable Development Goal commitments. Multiple converging political, health, and social forces could now drive support for a more integrated Canadian approach to global cancer control. Success will depend on the extent to which Canadian leaders and institutions can build consensus as a community and agree to work together. Collaboration should include agreement on the framing and prioritisation of the core issues, building a broad coalition base, aligning with priorities of international partners, and on a governance structure that reflects the principles of equity, diversity, and inclusion. This Series paper will discuss global cancer control within Canada's global health agenda, how Canada can address its history of colonisation and present-day disparities in its global work, and the challenges and opportunities of creating a Canadian global cancer control network.
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Affiliation(s)
- Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| | - Anna J Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada
| | - Reanne Booker
- Palliative and End-of-Life Care Services-Calgary Zone, Calgary, AB, Canada
| | | | - Heather Bryant
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Ophira Ginsburg
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Population Health and Perlmutter Cancer Centre, NYU Grossman School of Medicine, New York, NY, USA
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Mary Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Sumit Gupta
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | | | - Craig C Earle
- Canadian Partnership Against Cancer, Toronto, ON, Canada
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21
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Sedgewick JR, Ali A, Badea A, Carr T, Groot G. Service providers' perceptions of support needs for Indigenous cancer patients in Saskatchewan: a needs assessment. BMC Health Serv Res 2021; 21:848. [PMID: 34419035 PMCID: PMC8380380 DOI: 10.1186/s12913-021-06821-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Saskatchewan, Canada, Indigenous cancer care services at the municipal, provincial, and federal levels are intended to improve quality care but can result in a complex, fragmented, and multi-jurisdictional health care system. A multi-phase needs assessment project was initiated to document Indigenous cancer care needs. Guided by Indigenous patient partners, clinicians, academics, and policy makers, the present study reflects a needs assessment of Indigenous cancer supports from the perspectives of cancer care service providers. METHODS Qualitative data were collected through three focus groups with 20 service providers for cancer patients and their families at three Saskatchewan cities. Participants included chemotherapy and radiation nurses, social workers, a patient navigator, dieticians, and practicum students. A semi-structured interview guide was used to conduct the sessions to allow for freedom of responses. Data were recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS Service providers' perspectives were categorized into five themes: 1) addressing travel-related issues, 2) logistical challenges, 3) improvements to Indigenous-specific health care supports, 4) cultural sensitivity in health care, and 5) consistency in care. Supports provided differed for the two Indigenous groups, First Nations and Métis. Service providers made recommendations regarding how needs could be met. They saw language translation providers and Elder supports as important. Recommendations for improving travel were for medical taxis to include breaks so that passengers may alleviate any uncomfortable side effects of their cancer treatment. Further, Indigenous-specific accommodations were recommended for those requiring medical travel. These recommendations aligned with supports that are available in four other Canadian provinces. CONCLUSIONS These results identified gaps in supports and outlined recommendations to address barriers to cancer care from the perspectives of service providers. These recommendations may inform evidence-based health system interventions for Indigenous cancer patients and ultimately aim to improve cancer care services, quality of life, and health outcomes of Indigenous patients throughout their cancer journey.
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Affiliation(s)
- Jennifer R Sedgewick
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Anum Ali
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Andreea Badea
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
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22
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Letendre A, Garvey G, King A, King M, Crowshoe R, Bill L, Caron NR, Elias B. Creating a Canadian Indigenous Research Network Against Cancer to Address Indigenous Cancer Disparities. JCO Glob Oncol 2021; 6:92-98. [PMID: 32031447 PMCID: PMC6998023 DOI: 10.1200/jgo.19.00049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE In Canada, Indigenous peoples’ cancer rates have increased, but cancer screening rates tend to be lower. When coupled with poor cancer prognosis, treatment barriers, and inaccessible health care, Indigenous patients with cancer experience many unmet needs. Further complicating their journey is a multijurisdictional system that complicates cancer control services, treatments, patient supports, and cancer surveillance. To address these issues, the Canadian Indigenous Research Network Against Cancer (CIRNAC) was developed. This article describes the forerunners and consultative process that created the network and the consensus model developed to ground this network with, by, and for Indigenous peoples. METHODS A consultative workshop was held to (1) establish and increase network membership, (2) enhance partnerships with Indigenous communities and other researchers, and (3) develop an Indigenous-led research program, new funding, and related initiatives. RESULTS Participants viewed the CIRNAC as a reflective parallel network led by Indigenous peoples that would identify research priorities within Canada, assess how these priorities align with Indigenous patients’ cancer care and research needs, and cross-check to see if these priorities align with each other. The network would also advocate for Indigenous elders/knowledge holders and community grassroot processes to drive research and training, thus demonstrating the power of the community voice and lived experience in research. In addition, the network would foster research partnerships to investigate alternative Indigenous models for cancer prevention, care, treatment, and support. CONCLUSION The CIRNAC evolved as a viable vehicle to address cancer with, for, and by Indigenous peoples. The network is guided by a preamble, a set of aims, and an inclusion engagement circle model. It is evolving through major world initiatives, with the aim of formally becoming an internationally linked national network.
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Affiliation(s)
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Alexandra King
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Malcolm King
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Lea Bill
- Alberta First Nation Information Governance Centre, Calgary, Alberta, Canada
| | - Nadine R Caron
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Brenda Elias
- University of Manitoba, Winnipeg, Manitoba, Canada
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23
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Tobias JK, Tinmouth J, Senese LC, Jumah N, Llovet D, Kewayosh A, Rabeneck L, Dobrow M. Health Policy as a Barrier to First Nations Peoples' Access to Cancer Screening. ACTA ACUST UNITED AC 2021; 15:28-46. [PMID: 32176609 PMCID: PMC7075447 DOI: 10.12927/hcpol.2020.26132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: First Nations peoples in Ontario are facing increasing rates of cancer and have been found to have poorer survival. Cancer screening is an important strategy to improve cancer outcomes; yet, Indigenous people in Canada are less likely to participate in screening. Ontario has established organized breast, cervical and colorectal cancer screening programs; this paper examines the health policy context that informs these programs for First Nations peoples in the province. Method: This paper follows an embedded multiple-case study design, drawing upon a document review to outline the existing policy context and on key informant interviews to explore the aforementioned context from the perspective of stakeholders. Results: Policies created by agencies operating across federal, regional and provincial levels impact First Nations peoples' access to screening. Interviews identified issues of jurisdictional ambiguity, appropriateness of program design for First Nations persons and lack of cultural competency as barriers to participation in screening. Conclusion: Federal, provincial and regional policy makers must work in collaboration with First Nations peoples to overcome barriers to cancer screening created and sustained by existing policies.
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Affiliation(s)
- Joshua K Tobias
- Partnership Liaison Officer, Prevention & Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Jill Tinmouth
- Lead Scientist, ColonCancerCheck Program, Ontario Health (Cancer Care Ontario), Toronto, ON, Scientist and Staff Gastroenterologist, Sunnybrook Health Sciences, Toronto, ON
| | - Laura C Senese
- Research Project Coordinator, Sunnybrook Research Institute, Toronto, ON, Prevention & Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Naana Jumah
- Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON
| | - Diego Llovet
- Scientist, Prevention & Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, ON, Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Alethea Kewayosh
- Director, Indigenous Cancer Care Unit, Prevention & Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Linda Rabeneck
- Vice President, Prevention & Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Mark Dobrow
- Associate Professor, Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Varon ML, Baker E, Byers E, Cirolia L, Bogler O, Bouchonville M, Schmeler K, Hariprasad R, Pramesh CS, Arora S. Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:25-38. [PMID: 34292501 DOI: 10.1007/s13187-021-02031-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
Solving health problems requires not only the development of new medical knowledge but also its dissemination, particularly to underserved communities. The barriers to effective dissemination also contribute to the disparities in cancer care experienced most everywhere. This concern is particularly acute in low and middle-income countries which already bear a disproportionate burden of cancer, a situation that is projected to worsen. Project ECHO (Extension for Community Healthcare Outcomes) is a knowledge dissemination platform that can increase workforce capacity across many fields, including cancer care by scaling best practices. Here we describe how Project ECHO works and illustrate this with existing programs that span the cancer care continuum and the globe. The examples provided combined with the explanation of how to build effective Project ECHO communities provide an accessible guide on how this education strategy can be integrated into existing work to help respond to the challenge of cancer.
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Affiliation(s)
| | - Ellen Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Byers
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Lucca Cirolia
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Oliver Bogler
- Center for Cancer Training, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Bouchonville
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Roopa Hariprasad
- Division of Clinical Oncology, National Institute of Cancer Prevention and Research, New Delhi, India
| | | | - Sanjeev Arora
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
- UNM School of Medicine, Albuquerque, NM, USA.
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Gifford W, Rowan M, Dick P, Modanloo S, Benoit M, Al Awar Z, Wazni L, Grandpierre V, Thomas R, Sikora L, Graham ID. Interventions to improve cancer survivorship among Indigenous Peoples and communities: a systematic review with a narrative synthesis. Support Care Cancer 2021; 29:7029-7048. [PMID: 34028618 PMCID: PMC8464576 DOI: 10.1007/s00520-021-06216-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/09/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this systematic review is to synthesize the evidence on the types of interventions that have been utilized by Indigenous Peoples living with cancer, and report on their relevance to Indigenous communities and how they align with holistic wellness. METHODS A systematic review with narrative synthesis was conducted. RESULTS The search yielded 7995 unique records; 27 studies evaluating 20 interventions were included. The majority of studies were conducted in USA, with five in Australia and one in Peru. Study designs were cross-sectional (n=13); qualitative (n=5); mixed methods (n=4); experimental (n=3); and quasi-experimental (n=2). Relevance to participating Indigenous communities was rated moderate to low. Interventions were diverse in aims, ingredients, and outcomes. Aims involved (1) supporting the healthcare journey, (2) increasing knowledge, (3) providing psychosocial support, and (4) promoting dialogue about cancer. The main ingredients of the interventions were community meetings, patient navigation, arts, and printed/online/audio materials. Participants were predominately female. Eighty-nine percent of studies showed positive influences on the outcomes evaluated. No studies addressed all four dimensions of holistic wellness (physical, mental, social, and spiritual) that are central to Indigenous health in many communities. CONCLUSION Studies we found represented a small number of Indigenous Nations and Peoples and did not meet relevance standards in their reporting of engagement with Indigenous communities. To improve the cancer survivorship journey, we need interventions that are relevant, culturally safe and effective, and honoring the diverse conceptualizations of health and wellness among Indigenous Peoples around the world.
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Affiliation(s)
- Wendy Gifford
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
| | - Margo Rowan
- Rowan Research and Evaluation, Ottawa, Ontario, Canada
| | - Peggy Dick
- Algonquins of Pikwakanagan Health Services and Family Health Team, Pikwakanagan, Ontario, Canada
| | - Shokoufeh Modanloo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Maggie Benoit
- Algonquins of Pikwakanagan Health Services and Family Health Team, Pikwakanagan, Ontario, Canada
| | - Zeina Al Awar
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Liquaa Wazni
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Grandpierre
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D Graham
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada
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Alcindor T, Dumitra S, Albritton K, Thomas DM. Disparities in Cancer Care: The Example of Sarcoma-In Search of Solutions for a Global Issue. Am Soc Clin Oncol Educ Book 2021; 41:1-7. [PMID: 33770458 DOI: 10.1200/edbk_320463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Disparities in health care have an adverse effect on the outcome of disadvantaged patients with cancer. Patients may be at a disadvantage because of geographic isolation; insurance status; or racial, ethnic, or other factors. In this article, we examine how disparities affect the care of patients with sarcoma in the United States, Canada, and the Asia-Pacific region. Because of the rarity of sarcomas and their challenging diagnosis and complex treatment patterns, some professional or national guidelines stipulate that patients with sarcoma should be treated at centers of expertise by multidisciplinary teams. This recommendation, based on published evidence, is not always applicable because of various sociopolitical or patient-related factors. We are proposing solutions to overcome these obstacles in a practical and patient-centered way while acknowledging that disparities exist among countries as well as within any country.
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Affiliation(s)
| | | | | | - David M Thomas
- Garvan Institute of Medical Research, Darlinghurst, Australia
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Whop LJ, Smith MA, Butler TL, Adcock A, Bartholomew K, Goodman MT, Winer RL, Milosevic E, Lawton B. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144:106314. [PMID: 33678228 DOI: 10.1016/j.ypmed.2020.106314] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 11/02/2020] [Indexed: 01/16/2023]
Abstract
Achieving the World Health Organisation (WHO) cervical cancer elimination target of fewer than four new cases per 100,000 woman-years requires scaling up HPV vaccination of girls, cervical screening, and pre-cancer and cancer treatment. We reviewed data from four high-income colonised countries (Australia, Canada, Aotearoa New Zealand (NZ), and the United States (US)) to identify how each is currently performing compared to the cervical cancer incidence elimination and triple-intervention targets, nationally and in Indigenous women. We also summarise barriers and enablers to meeting targets for Indigenous women. To achieve elimination, cervical cancer incidence must be reduced by 74% in Indigenous women in Australia, and 63% in Maori women in NZ; data were not published in sufficient detail to compare incidence in Indigenous women in Canada or the US to the WHO target. Only Australia meets the vaccination coverage target, but uptake appears comparatively equitable within Australia, NZ and the US, whereas there appears to be a substantial gap in Canada. Screening coverage is lower for Indigenous women in all four countries though the differential varies by country. Currently, only Australia universally offers HPV-based screening. Data on pre-cancer and cancer treatment were limited in all countries. Large inequities in cervical cancer currently exist for Indigenous peoples in Australia, Canada, New Zealand and the US, and elimination is not on track for all women in these countries. Current data gaps hinder improvements. These countries must urgently address their systemic failure to care and provide health care for Indigenous women.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Auckland, New Zealand
| | - Marc T Goodman
- Cedars-Sinai Cancer and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Milosevic
- Canadian Partnership Against Cancer, Toronto, Canada; Global Health Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
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Simkin J, Nash SH, Barchuk A, O'Brien DK, Erickson AC, Hanley B, Hannah H, Corriveau A, Larsen IK, Skovlund CW, Larønningen S, Dummer TJB, Bruce MG, Ogilvie G. Stomach Cancer Incidence and Mortality Trends among Circumpolar Nations. Cancer Epidemiol Biomarkers Prev 2021; 30:845-856. [PMID: 33627381 DOI: 10.1158/1055-9965.epi-20-1618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stomach cancer incidence and mortality rates are declining across circumpolar nations, but the burden may not be distributed equally across subpopulations, including Indigenous peoples. Our objective was to examine stomach cancer incidence and mortality trends across circumpolar populations. METHODS Cancer incidence and mortality data from 1999-2016 were obtained from the Canadian Cancer Registry, Canadian Vital Statistics, CDC WONDER, NORDCAN, Northwestern Russian cancer registries, and National Cancer Reports. The direct method was used to calculate 10-year rolling age-standardized incidence and mortality rates to the world (WHO 2000-2025) and 2011 Canadian standard populations. Standardized incidence rate ratios (SRR) were calculated. Data were stratified by sex, year, and region. U.S. data were broken down by race [White; American Indian/Alaska Native (AIAN)]. Race data were not available from non-U.S. cancer registries. RESULTS Most populations showed declining incidence and mortality rates over time. Incidence rates among Greenland males and females, Alaska AIAN males and females, and Northern Canadian both sexes were elevated compared with regional counterparts and remained stable. The largest male SRR was observed among Alaska AIAN versus Alaska Whites [SRR = 3.82; 95% confidence interval (95% CI), 2.71-5.37]. The largest female SRR was observed among Alaska AIAN versus Alaska Whites (SRR = 4.10; 95% CI, 2.62-6.43). CONCLUSIONS Despite stomach cancer incidence and mortality rates declining overall, some northern and Indigenous populations experience elevated and stable incidence and mortality rates. IMPACT There is a need to address disparities observed among circumpolar subpopulations. Given similarities in incidence, mortality, and risk factor prevalence across circumpolar regions, addressing disparities could benefit from coordinated international action.
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Affiliation(s)
- Jonathan Simkin
- Cancer Control Research, BC Cancer, British Columbia, Canada. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Sarah H Nash
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Anton Barchuk
- European University at Saint Petersburg, Saint Petersburg, Russia.,NN Petrov National Cancer Research Medical Center of Oncology, Saint Petersburg, Russia
| | - David K O'Brien
- Alaska Cancer Registry, Health Analytics and Vital Records Section (HAVRS), Alaska Department of Health and Social Services, Anchorage, Alaska
| | - Anders C Erickson
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Brendan Hanley
- Office of the Chief Medical Officer of Health, Department of Health and Social Services, Government of Yukon, Whitehorse, Yukon Territory, Canada
| | - Heather Hannah
- Department of Health and Social Services, Government of Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Andre Corriveau
- Department of Health and Social Services, Government of Northwest Territories, Yellowknife, Northwest Territories, Canada
| | | | | | | | - Trevor J B Dummer
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada.,Centre of Excellence in Cancer Prevention, School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Gina Ogilvie
- Cancer Control Research, BC Cancer, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada.,Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, British Columbia, Canada
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29
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Coffee Consumption and Its Inverse Relationship with Gastric Cancer: An Ecological Study. Nutrients 2020; 12:nu12103028. [PMID: 33023243 PMCID: PMC7601092 DOI: 10.3390/nu12103028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/1970] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
Coffee is the second most popular drink worldwide, and it has various components with antioxidant and antitumor properties. Due to its chemical composition, it could act as an antitumor substance in the gastrointestinal tract. The objective of this study was to explore the relationship between coffee consumption and the incidence/mortality of stomach cancer in the highest-consuming countries. An ecological study using Spearman’s correlation coefficient was performed. The WorldAtlas’s dataset of coffee consumption and the incidence/mortality rates database of the International Agency for Research were used as sources of information. A total of 25 countries were entered to the study. There was an inverse linear correlation between coffee consumption in kg per person per year and estimated age-adjusted incidence (r = −0.5984, p = 0.0016) and mortality (r = −0.5877, p = 0.0020) of stomach cancer. Coffee may potentially have beneficial effects on the incidence and mortality of stomach cancer, as supported by the data from each country analyzed.
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Carr T, Arcand L, Roberts R, Sedgewick J, Ali A, Groot G. The experiences of Indigenous people with cancer in Saskatchewan: a patient-oriented qualitative study using a sharing circle. CMAJ Open 2020; 8:E852-E859. [PMID: 33303571 PMCID: PMC7881746 DOI: 10.9778/cmajo.20200012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although disparities in cancer rates, later diagnoses and lower survival rates between Indigenous and non-Indigenous people have been documented, little is known about how Indigenous patients with cancer encounter the health care system. We explored perceptions and experiences of Indigenous patients with cancer and their families to understand better how 2 key concepts - trust and world view - influence cancer care decisions. METHODS In this patient-oriented study that included participation of 2 patient partners, qualitative data were collected from Indigenous patients with cancer and their families using an Indigenous method of sharing circles. The sharing circle occurred at a culturally appropriate place, Wanuskewin Heritage Park, Saskatoon, on Sept. 22, 2017. The first patient partner started the sharing circle by sharing their cancer journey, thus engaging the Indigenous methodology of storytelling. This patient partner was involved in selecting the data collection method and recruiting participants through snowballing and social media. Trust and world view were employed as meta themes to guide our examination of the data. In keeping with Indigenous methodology, interview transcripts were analyzed using narrative analysis. The themes were reviewed and verified by a second Indigenous patient partner. RESULTS There were 14 participants in the sharing circle. The 2 meta themes, trust and world view, comprised 8 subthemes. The meta theme trust included mistrust with diagnosis and Western treatment after cancer therapy, protection of Indigenous medicine and physician expertise with treatment recommendations. The world view meta theme included the following subthemes: best of both worlds, spiritual beliefs, required to be strong for family and importance of knowing Indigenous survivors. INTERPRETATION This study displayed complex relations between trust and world view in the cancer journeys of Indigenous patients and their families. These findings may assist health care providers in gaining a better understanding of how trust and world view affect the decision-making of Indigenous patients regarding cancer care.
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Affiliation(s)
- Tracey Carr
- Community Health and Epidemiology (Carr, Sedgewick, Ali, Groot), University of Saskatchewan, Saskatoon, Sask.; Patient Partner (Arcand), Whitecap, Sask.; Gwenna Moss Centre for Teaching and Learning (Roberts), Centre for Teaching and Learning (Roberts) and College of Medicine (Groot), University of Saskatchewan, Saskatoon, Sask.
| | - Lorna Arcand
- Community Health and Epidemiology (Carr, Sedgewick, Ali, Groot), University of Saskatchewan, Saskatoon, Sask.; Patient Partner (Arcand), Whitecap, Sask.; Gwenna Moss Centre for Teaching and Learning (Roberts), Centre for Teaching and Learning (Roberts) and College of Medicine (Groot), University of Saskatchewan, Saskatoon, Sask
| | - Rose Roberts
- Community Health and Epidemiology (Carr, Sedgewick, Ali, Groot), University of Saskatchewan, Saskatoon, Sask.; Patient Partner (Arcand), Whitecap, Sask.; Gwenna Moss Centre for Teaching and Learning (Roberts), Centre for Teaching and Learning (Roberts) and College of Medicine (Groot), University of Saskatchewan, Saskatoon, Sask
| | - Jennifer Sedgewick
- Community Health and Epidemiology (Carr, Sedgewick, Ali, Groot), University of Saskatchewan, Saskatoon, Sask.; Patient Partner (Arcand), Whitecap, Sask.; Gwenna Moss Centre for Teaching and Learning (Roberts), Centre for Teaching and Learning (Roberts) and College of Medicine (Groot), University of Saskatchewan, Saskatoon, Sask
| | - Anum Ali
- Community Health and Epidemiology (Carr, Sedgewick, Ali, Groot), University of Saskatchewan, Saskatoon, Sask.; Patient Partner (Arcand), Whitecap, Sask.; Gwenna Moss Centre for Teaching and Learning (Roberts), Centre for Teaching and Learning (Roberts) and College of Medicine (Groot), University of Saskatchewan, Saskatoon, Sask
| | - Gary Groot
- Community Health and Epidemiology (Carr, Sedgewick, Ali, Groot), University of Saskatchewan, Saskatoon, Sask.; Patient Partner (Arcand), Whitecap, Sask.; Gwenna Moss Centre for Teaching and Learning (Roberts), Centre for Teaching and Learning (Roberts) and College of Medicine (Groot), University of Saskatchewan, Saskatoon, Sask
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Diaz A, Soerjomataram I, Moore S, Whop LJ, Bray F, Hoberg H, Garvey G. Collection and Reporting of Indigenous Status Information in Cancer Registries Around the World. JCO Glob Oncol 2020; 6:133-142. [PMID: 32031453 PMCID: PMC6998012 DOI: 10.1200/jgo.19.00119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Worldwide, Indigenous people often have disproportionally worse health and lower life expectancy than their non-Indigenous counterparts. Despite the impact of cancer on life expectancy, little is known about the burden of cancer for Indigenous people primarily because of the paucity of data. We investigated the collection and reporting of Indigenous status information among a global sample of population-based cancer registries (PBCRs). PARTICIPANTS AND METHODS An online survey was e-mailed to eligible registries using set inclusion criteria. Respondents were asked questions on the collection, reporting, and quality assessment of Indigenous status in their registers. RESULTS Eighty-three PBCRs from 25 countries were included. Of these, 66% reported that their registry collected Indigenous status data, although the quality of this variable had been assessed in less than half in terms of completeness (38%) and accuracy (47%). Two thirds of PBCRs who collected Indigenous status data (67%), from nine of 25 countries responded that cancer statistics for Indigenous people were reported using registry data. Key barriers to the collection of Indigenous status information included the lack of data collection at the point of care (79%), lack of transfer of Indigenous status to the cancer registry (46%), inadequate information systems (43%), and legislative limitations (32%). Important variations existed among world regions, although the lack of Indigenous status data collection at the point of care was commonly reported across all regions. CONCLUSION High-quality data collection is lacking for Indigenous peoples in many countries. To ensure the design and implementation of cancer control activities required to reduce disparities for Indigenous populations, health information systems, including cancer registries, need to be strengthened, and this must be done in dialogue with Indigenous leaders.
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Affiliation(s)
- Abbey Diaz
- Charles Darwin University, Casuarina, NT, Australia
| | | | | | - Lisa J. Whop
- Charles Darwin University, Casuarina, NT, Australia
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Hana Hoberg
- Charles Darwin University, Casuarina, NT, Australia
| | - Gail Garvey
- Charles Darwin University, Casuarina, NT, Australia
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Horrill TC, Dahl L, Sanderson E, Munro G, Garson C, Taylor C, Fransoo R, Thompson G, Cook C, Linton J, Schultz ASH. Comparing cancer incidence, stage at diagnosis and outcomes of First Nations and all other Manitobans: a retrospective analysis. BMC Cancer 2019; 19:1055. [PMID: 31694679 PMCID: PMC6836370 DOI: 10.1186/s12885-019-6296-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/27/2019] [Indexed: 11/21/2022] Open
Abstract
Background Globally, epidemiological evidence suggests cancer incidence and outcomes among Indigenous peoples are a growing concern. Although historically cancer among First Nations (FN) peoples in Canada was relatively unknown, recent epidemiological evidence reveals a widening of cancer related disparities. However evidence at the population level is limited. The aim of this study was to explore cancer incidence, stage at diagnosis, and outcomes among status FN peoples in comparison with all other Manitobans (AOM). Methods All cancers diagnosed between April 1, 2004 and March 31, 2011 were linked with the Indian Registry System and five provincial healthcare databases to compare differences in characteristics, cancer incidence, and stage at diagnosis and mortality of the FN and AOM cohorts. Cox proportional hazard regression models were used to examine mortality. Results The FN cohort was significantly younger, with higher comorbidities than AOM. A higher proportion of FN people were diagnosed with cancer at stages III (18.7% vs. 15.4%) and IV (22.4% vs. 19.9%). Cancer incidence was significantly lower in the FN cohort, however, there were no significant differences between the two cohorts after adjusting for age, sex, income and area of residence. No significant trends in cancer incidence were identified in either cohort over time. Mortality was generally higher in the FN cohort. Conclusions Despite similar cancer incidence, FN peoples in Manitoba experience poorer survival. The underlying causes of these disparities are not yet understood, particularly in relation to the impact of colonization and other determinants of health.
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Affiliation(s)
- Tara C Horrill
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, R3T 2N2, Canada.
| | - Lindsey Dahl
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Garry Munro
- Cree Nation Tribal Health Centre, The Pas, Canada
| | - Cindy Garson
- Interlake Reserves Tribal Council, Winnipeg, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Genevieve Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, R3T 2N2, Canada
| | - Catherine Cook
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Janice Linton
- Indigenous Health Librarian, University of Manitoba, Winnipeg, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, R3T 2N2, Canada
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Horrill TC, Dahl L, Sanderson E, Munro G, Garson C, Fransoo R, Thompson G, Cook C, Linton J, Schultz ASH. Cancer incidence, stage at diagnosis and outcomes among Manitoba First Nations people living on and off reserve: a retrospective population-based analysis. CMAJ Open 2019; 7:E754-E760. [PMID: 31852681 PMCID: PMC6934385 DOI: 10.9778/cmajo.20190176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Substantial cancer-related disparities exist between First Nations and non-Indigenous Canadians. The objectives of this study were to compare cancer incidence, stage at diagnosis and mortality outcomes between Status First Nations people living on reserve and off reserve in Manitoba. METHODS We conducted a retrospective analysis of population-level administrative health databases in Manitoba. Cancers diagnosed between Apr. 1, 2004, and Mar. 31, 2011, were linked with the Indian Registry System and 5 provincial databases. We compared differences in baseline characteristics, cancer incidence, site and stage at diagnosis between Status First Nations patients living on and off reserve. Linear regression models examined trends in annual cancer incidence. Cox proportional hazard regression models examined mortality. RESULTS There were 1524 newly diagnosed cancers among Status First Nations people in Manitoba between Apr. 1, 2004, and Mar. 31, 2011. First Nations people living on reserve were significantly older than those living off reserve (p < 0.001) and had higher Charlson Comorbidity Index scores at diagnosis (p = 0.01). A lower proportion of on-reserve patients than off-reserve patients were diagnosed with stage I cancers (21.7% v. 26.9%, p = 0.02). There were no differences in annual cancer incidence between groups. The adjusted incidence of cancer over the combined study years was higher in the off-reserve group than in the on-reserve group (287.9 v. 247.9 per 100 000, p = 0.02). No significant differences in mortality were found. INTERPRETATION The lower proportion of on-reserve patients diagnosed with cancer at stage I is concerning, as it suggests less access to screening services or delays in diagnosis. Further research is needed to understand patterns in diagnosis and differences in cancer site and overall cancer incidence between First Nations people living on and off reserve.
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Affiliation(s)
- Tara C Horrill
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
| | - Lindsey Dahl
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Esther Sanderson
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Garry Munro
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Cindy Garson
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Randy Fransoo
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Genevieve Thompson
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Catherine Cook
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Janice Linton
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
| | - Annette S H Schultz
- College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man
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Access to cancer care among Indigenous peoples in Canada: A scoping review. Soc Sci Med 2019; 238:112495. [DOI: 10.1016/j.socscimed.2019.112495] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
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Social disparities and symptom burden in populations with advanced cancer: specialist palliative care providers' perspectives. Support Care Cancer 2019; 27:4733-4744. [PMID: 30972644 DOI: 10.1007/s00520-019-04726-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
Disparities in access to palliative care services for populations with social disparities have been reported in Western countries. Studies indicate that these populations tend to report higher symptom distress than other population groups. We need to further investigate how social disparities influence symptom burden to improve symptom relief in these populations. PURPOSE To examine the perspectives of specialist palliative care providers concerning the relationship between social disparities and symptom burden in populations with advanced cancer. METHODS Two sequential qualitative studies that followed a combination of interpretive and critical methodologies. The interpretive approach was outlined by van Manen's hermeneutic phenomenology while the critical component was informed by the works of Paulo Freire. Participants involved two specialist palliative care teams from a large acute care hospital and a large cancer center in Western Canada. Participants included 11 palliative care providers including registered nurses, nurse practitioners, physicians, and pharmacists. RESULTS Participants perceived that social conditions that might aggravate symptom burden included low income, low education, lack of social support, language barriers, and rurality. The relationship between income and symptom burden reflected diverse views. Participants identified populations prone to complex symptom burden including homeless individuals, Indigenous people, people with a history of addictions, and people with mental health or psychosocial issues. CONCLUSION Participants perceived that social disparities may increase symptom complexity in populations with advanced cancer. Participants did not identify ethnicity and gender as influencing symptom burden. Further research is needed to examine the interactions of social disparities, patient individuality, and symptom burden.
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Lines LA, Jardine CG. Connection to the land as a youth-identified social determinant of Indigenous Peoples' health. BMC Public Health 2019; 19:176. [PMID: 30744592 PMCID: PMC6371607 DOI: 10.1186/s12889-018-6383-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social determinants of Indigenous health are known to include structural determinants such as history, political climate, and social contexts. Relationships, interconnectivity, and community are fundamental to these determinants. Understanding these determinants from the perspective of Indigenous youth is vital to identifying means of alleviating future inequities. METHODS In 2016, fifteen Yellowknives Dene First Nation (YKDFN) youth in the Canadian Northwest Territories participated in the 'On-the-Land Health Leadership Camp'. Using a strength- and community-based participatory approach through an Indigenous research lens, the YKDFN Wellness Division and university researchers crafted the workshop to provide opportunities for youth to practice cultural skills, and to capture the youth's perspectives of health and health agency. Perspectives of a healthy community, health issues, and health priorities were collected from youth through sharing circles, PhotoVoice, mural art, and surveys. RESULTS The overall emerging theme was that a connection to the land is an imperative determinant of YKDFN health. Youth identified the importance of a relationship to land including practicing cultural skills, Elders passing on traditional knowledge, and surviving off the land. The youth framed future health research to include roles for youth and an on-the-land component that builds YKDFN culture, community relations, and traditional knowledge transfer. Youth felt that a symbiotic relationship between land, environment, and people is fundamental to building a healthy community. CONCLUSION Our research confirmed there is a direct and critical relationship between structural context and determinants of Indigenous Peoples' health, and that this should be incorporated into health research and interventions.
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Affiliation(s)
- Laurie-Ann Lines
- Health Promotion and Socio-behavioural Sciences PhD Student, School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Cynthia G Jardine
- Tier 1 Canada Research Chair in Health and Community, Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, Canada.
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Mazereeuw MV, Withrow DR, Diane Nishri E, Tjepkema M, Marrett LD. Cancer incidence among First Nations adults in Canada: follow-up of the 1991 Census Mortality Cohort (1992-2009). CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:700-709. [PMID: 29981110 PMCID: PMC6964591 DOI: 10.17269/s41997-018-0091-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/24/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Estimate site-specific cancer incidence rates for a wide range of cancers in First Nations adults in Canada, and compare these with rates in non-Aboriginal adults. METHODS Responses from persons aged 25 and older to the 1991 Long Form Census were linked to national mortality and cancer databases. First Nations- and non-Aboriginal-specific incidence rates were age-standardized to the world standard population. The sex- and site-specific relative risks (RR) of cancer in First Nations compared to those in non-Aboriginal adults were estimated with Poisson regression. Results were stratified by residence on-reserve (all cancers combined) and region of Canada (four most common cancer sites). RESULTS Compared to non-Aboriginal adults, First Nations had higher incidence of colon and rectum, kidney, cervix, and liver cancers and lower incidence of prostate, breast, bladder, uterus, ovary, and brain cancers, as well as non-Hodgkin lymphoma, leukemia, and melanoma. First Nations women additionally had higher incidence of stomach, gallbladder, and laryngeal cancers and lower incidence of thyroid cancers compared to non-Aboriginal women. The higher relative incidence of stomach and gallbladder cancers was observed only among First Nations adults who reported living on-reserve. Incidence of lung cancer was similar for First Nations and non-Aboriginal adults nationally, though variation by region of Canada was observed. CONCLUSION First Nations people in Canada have disproportionately high rates of certain cancers, providing evidence to support public health policy and programming. More research is needed to identify factors contributing to the significantly lower incidence observed for various cancer types. Novel methods for studying disparities in cancer incidence among First Nations people are required to support ongoing cancer control planning and advocacy.
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Affiliation(s)
- Maegan V Mazereeuw
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.
- Canadian Institute for Health Information, 4110 Yonge Street, Suite 300, Toronto, Ontario, M2P 2B7, Canada.
| | - Diana R Withrow
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - E Diane Nishri
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Michael Tjepkema
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Loraine D Marrett
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Otolaryngology-Related Disorders in Underserved Populations, Otolaryngology Training and Workforce Considerations in North America. Otolaryngol Clin North Am 2018; 51:685-695. [DOI: 10.1016/j.otc.2018.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wyndham-West M, Durand N, Santoro A. Betwixt and Between Well and Sick in Cervical Precancer: Canadian Women's Experiences of Recurring HPV Infections and HPV Vaccination. Can J Nurs Res 2018; 50:120-132. [PMID: 29759001 DOI: 10.1177/0844562118763496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Background This research fuses the experiences of a precancer diagnosis with the decision-making surrounding a vaccine that can protect against human papillomavirus strains that women may not have been exposed to. The interviewee cohort is of note as half the women were in their 30s and 40s and 75% were over the age of 26. These groupings are often overlooked in media discourses and narrative research surrounding human papillomavirus and the human papillomavirus vaccine. Purpose Womens' diagnoses and treatment experiences, including colposcopies, biopsies, and Loop Electrosurgical Excision Procedures, are chronicled to highlight a liminal, precancerous state-one in which they are not deemed healthy, but nor have they been diagnosed with cancer. These are emotion-filled experiences that are ridden with anxiety and fear, but also ones that are structured with self-care strategies to contain human papillomavirus infections and the risk of cervical cancer. Methods Twenty women who attended Sunnybrook Health Sciences Centre's human papillomavirus vaccination clinic were interviewed and their narratives were documented and analyzed to determine their experiences surrounding human papillomavirus infections and precancer as well as their motivations for human papillomavirus vaccination. Results The decision to undergo human papillomavirus vaccination was a self-care strategy that accompanied treatment procedures and was a means to reduce cervical cancer risk. While encouraged with the human papillomavirus vaccine's potential to curb cervical cancer, they had a tempered view of the vaccine and its effectiveness in their cases, given their medical histories. Conclusions The research provides an in-depth accounting of an often overlooked grouping in human papillomavirus and human papillomavirus vaccination research and media discourse which, generally, focuses upon middle-school-aged girls and university-/college-aged women. In addition, the research provides recommendations for practice for cervical precancer diagnoses going forward.
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Affiliation(s)
| | - Nancy Durand
- 2 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aimee Santoro
- 3 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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McGahan CE, Linn K, Guno P, Johnson H, Coldman AJ, Spinelli JJ, Caron NR. Cancer in First Nations people living in British Columbia, Canada: an analysis of incidence and survival from 1993 to 2010. Cancer Causes Control 2017; 28:1105-1116. [PMID: 28887646 DOI: 10.1007/s10552-017-0950-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND For First Nations (FN) peoples living in British Columbia (BC), little is known regarding cancer in the population. The aim of this study was to explore cancer incidence and survival in the FN population of BC and compare it to the non-FN population. METHODS All new cancers diagnosed from 1993 to 2010 were linked to the First Nations Client File (FNCF). Age-standardized incidence rates (ASIR) and rate ratios, and 1- and 5-year cause-specific survival estimates and hazard ratios were calculated. Follow-up end date for survival was December 31, 2011 and follow-up time was censored at a maximum of 15 years. RESULTS ASIR of colorectal cancer (male SRR = 1.42, 95% CI 1.25-1.61; female SRR = 1.21, 95% CI 1.06-1.38) and cervical cancer (SRR = 1.84, 95% CI 1.45-2.33) were higher overall in FN residents in BC, compared to non-FN residents. Incidence rates of almost all other cancers were generally similar or lower in FN populations overall and by sex, age, and period categories, compared to non-FN residents. Trends in ASIR over time were similar except for lung (increasing for FN, decreasing for non-FN) and colorectal cancers (increasing for FN, decreasing for non-FN). Conversely, survival rates were generally lower for FN, with differences evident for some cancer sites at 1 year following diagnosis. CONCLUSION FN people living in BC face unique cancer issues compared to non-FN people. Higher incidence and lower survival associated with certain cancer types require further research to look into the likely multifaceted basis for these findings.
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Affiliation(s)
| | - Kevin Linn
- First Nations Health Authority, Vancouver, BC, Canada
| | - Preston Guno
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | - John J Spinelli
- British Columbia Cancer Agency, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Nadine R Caron
- British Columbia Cancer Agency, Vancouver, BC, Canada.
- University of British Columbia, Vancouver, BC, Canada.
- , 308 - 1669 Victoria St, Prince George, BC, V2L 2L5, Canada.
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